Current Reimbursement Landscape for Re‑Treatment with Anti-PD-(L)1 Agents after Treatment in Early-Stage Cancers: A Payer Survey

OBJECTIVES:

Current evidence suggests that reintroducing immunotherapy after its discontinuation can benefit selected patients. This study aimed to understand current and anticipated reimbursement policies for re‑treatment with anti-PD-(L)1s following their use in early-stage cancers.

METHODS:

A survey (informed by a targeted literature review -TLR-) involving 54 payers from France, Germany, Italy, Spain, UK, USA, Canada and Australia, evaluated factors associated with reimbursement decisions for re-treatment with anti-PD(L)1s following their use in early-stage cancers (triple-negative breast cancer, melanoma, non-small cell lung cancer, and renal cell carcinoma).

RESULTS:

Payer responses showed variability in reimbursement of re‑treatment with anti-PD-(L)1s following their use in early-stage cancers in selected countries. Across cancer types, re‑treatment with anti-PD-(L)1s was considered fully reimbursed (according to 24-29% of payers), reimbursed with restrictions (29-37%), or not reimbursed (35-47%). Key themes influencing restricted reimbursement included: disease-free interval length (43%), need to request funding (33%), and tumor-specific (26%) or stage-specific restrictions (24%).

Similar proportions of payers reported full or restricted reimbursement of re‑treatment after discontinuation due to immune-related adverse events, after a fixed-duration of therapy, and after intervening treatment (73-76%). Across markets, 59-64% of payers reported (restricted) reimbursement for re‑treatment when discontinuation occurred due to relapse while on treatment.

The main barriers to reimbursing re‑treatment with anti-PD-(L)1s following their use in early-stage cancers were reported to include lack of comparative evidence of clinical benefit (85%), cost/budget-impact (52%), and cost-effectiveness results (39%). Most payers (70%) reported that access challenges would not differ across tumor types; differences, if any, would center on tumor types with more evidence available for retreatment (e.g., melanoma).

CONCLUSIONS:

Reimbursement (with restrictions) with anti-PD-(L)1-based re‑treatment with anti-PD-(L)1s following their use in early-stage cancers was reported by the majority of payers. Further clinical evidence would be helpful to better inform re‑treatment funding decisions.